Exercise Training in High-Risk Populations: A Scientific Statement From the American Heart Association.

Authors

Jerome L Fleg, Jessica R Golbus, Jonathan Afilalo, William K Cornwell, Sara Cuccurullo, Cynthia M Dougherty, Daniel E Forman, Kim M Huffman, Sherrie Khadanga, Donna Mancini, Kari Nytrøen, Gordon R Reeves, J Andrew Taylor, American Heart Association Exercise, Cardiac Rehabilitation, and Sports Cardiology Science Committee of the Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Quality of Care and Outcomes Research; and Stroke Council

Published in

Circulation. Jul 09, 2026. Epub Jul 09, 2026.

Abstract

There is broad consensus on the benefits of aerobic exercise training in patients with cardiovascular disease to improve cardiorespiratory fitness and lower the risk of adverse cardiovascular events. However, certain high-risk populations such as those with frailty, stroke, spinal cord injury, rheumatological conditions, or genetic cardiomyopathies and recipients of advanced heart failure therapies or cardiac implantable electronic devices warrant special considerations with regard to exercise training. This scientific statement summarizes the present state and future directions of exercise training for these high-risk populations, including functional deficits, responses to exercise training, modifications in training programs required to maximize safety and efficacy, and knowledge gaps in this field. Key findings common across most of these high-risk populations include (1) increased barriers to participation in exercise training at multiple levels; (2) low baseline cardiorespiratory fitness, creating heightened need for exercise interventions; (3) modifications to exercise prescription, frequently emphasizing strength, balance, and flexibility in addition to aerobic training, as well as accommodations with enhanced supervision and specialized equipment as needed; and (4) functional and quality-of-life gains in response to appropriately designed exercise programs that match or exceed those in more traditional populations. Future research is needed to further develop patient-centered training regimens designed to address the unique and heterogeneous needs of these populations, evaluate their impact on clinical and patient-centered outcomes, and advance scalable and equitable delivery of exercise therapies proven safe and effective.

PMID:
42422933
Bibliographic data and abstract were imported from PubMed on 09 Jul 2026.

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